Food Allergies - The View From Both Sides: Doctor and Parent

It is always a great honour and responsibility to speak publicly on matters of importance in health and well-being - and for all of us here tonight food allergies directly affect the lives of our families.

The term 'food allergy' may sound tame and manageable, but food allergies in an extreme form - such as anaphylaxis - are a life and death matter.

They require patience, vigilance, care and love.

An anaphylactic child can be a fragile being indeed.

But with greater awareness in the family and in the schools and in the broader community, food allergies of all kinds - the mild to the dangerous - can be managed.

Children with food allergies - even anaphylactic kids - can lead normal and healthy lives. They need not miss out.

As AMA President, I often get called to speak on issues that raise awareness, have a public health message, or improve the provision of services for certain groups of people.

But tonight is special for me. I have an anaphylactic child. I know first hand the problems. I know first hand the solutions - the hope.

The theme for the 2006 Food Allergy Awareness Week is SAFE - Support Allergic Friends Everywhere.

It is a theme that is neat, simple, pertinent and vital - and very real.

When I was taking my son to hospital in an ambulance, having seen him glowing red after eating a tiny piece of a nutty chocolate bar, with the nuts removed manually, it was pretty scary.

We had five doctors in the house but no adrenaline to hand!

This experience changed our lives and made us much more aware of the wide number of foods that contained nuts and eggs.

Oh yes, when tested we found egg allergy, too.

And yes, there is asthma and eczema, to boot - the atopic stereotype.

Interestingly, when he could talk, my son told us that some products would make his mouth and throat burn if they contained the wrong stuff!

Apart from my own son, we seem surrounded by more and more people with severe food allergies.

My AMA Queensland counterpart, Dr Steve Hambleton, has one family member with severe anaphylaxis problems with nuts and his wife is allergic to prawns.

While sharing dinner with Steve and his wife at a function recently, we were rudely interrupted and shocked when we discovered the fish mousse contained prawn!

Despite there being 100 doctors present, there was no adrenaline and a short ajournment to the local Emergency department restored normality.

A colleague in our practice has a daughter with nut allergy.

Our neighbour's daughter does, too.

And the same with about 30 kids in our primary school.

They all need to have access to the EPIPEN.

It's quite common when you ask or find out.

And it's not faddy parents. Food allergies are real. They are dangerous and can be life threatening.

So, awareness is important and I'd like to congratulate Maria Said and Anaphylaxis Australia on their gargantuan efforts to raise awareness and understanding of food allergies.

Let's hope that the understanding grows.

It used to be said that kids could 'live on peanut butter'. But today we know that they could die on peanut butter, too.

Luckily, the kids of today - the ones with the peanut and other food allergies - do have other choices.

And they can be fun choices and tasty choices.

But the kids without allergies can help as well. They can 'live on peanut butter' at home.

Asking them not to bring peanut butter and other allergy foods to school or on a plane or to a party or on an outing or sport reduces the risk to others.

This may limit their choice, but they do actually have a choice or a broader range of choices.

And this is a key part of awareness and understanding.

Letting kids know that it's not about telling them what they can and can't eat - it's all about helping your mates by giving them a safe environment and giving everyone - kids, parents and teachers - greater peace of mind.

They are exercising their responsibilities as thoughtful citizens by understanding the dangers they may pose to those around them who do not have the choice to eat nuts and the like!

Education is key.

In our school, they have an excellent set-up with photos identifying the known allergic kids, and easy access to their own Epipens in class and in the sick bay.

Staff are all trained, and although initially wobbly, very resolute and capable and confident should they be required to act. Even on camp, they are now able to relax with the extra responsibility.

Parents of mates are getting used to substituting their food choices at parties, for instance, and not being fazed to have the Epipen bag in their charge!

It's not just the allergic person themselves that is involved!

Another piece of gratuitous advice I give out is to keep the nuts separate.

For instance, on my way here this morning in the airline lounge, the beautiful, fresh, safe fruit salad was dressed with nuts.

This was a kind and thoughtful gesture to make an appetising snack better: but, hey presto, a disaster - and a removal of a usually safe option for folk like my son!

Don't sprinkle nuts on otherwise safe foods and increase the risk and reduce the limited choices even further.

Similarly, opening packets of nuts in confined places is an unnecessary risk, especially in an aircraft cabin. There are equally tasty, appetising alternatives without the same risk.

I quote the British Airways policy on this: sadly I could not find any such statement from our national carrier:

"To help accommodate the needs of peanut allergy sufferers British Airways operates a Peanut Policy onboard its aircraft.

Peanuts are not included within British Airways aircraft meals or snacks in any cabin, however we cannot guarantee against accidental cross-contamination that may occur within flight kitchens.

The only exception to this policy is on our long haul flights to the Far East where Peanut Satay may be included in the menu.

Peanuts as a cocktail accompaniment have also been withdrawn from all cabins."

Then there is the warning you find on just about anything these days - May contain traces of nuts … my big headache.

Have you ever looked on the back of packets of biscuits, chocolate and the like? Even the supposed 'nut free' varieties all carry this warning.

It must be the bane of our lives as parents of a child with severe nut allergy.

I understand the dilemma of reducing risk but should it be to the level of a cop-out and labelling everything as 'may contain'.

I would urge greater responsibility with manufacturing and labelling rather than blanket and inaccurate labelling, which again removes access and reduces choices.

The theme must be to minimise harm and maximise understanding!

Maria Said and John M Weiner made this important point in the Medical Journal of Australia a couple of years ago, and I quote:

As you may know, food allergens that must be declared include egg, milk, peanut, tree nuts, sesame, crustaceans, fish, soy, and cereals containing gluten.

Education of children as well as their carers is crucial so that teenagers can walk away from childhood with skills to help keep them safe.

There are simple principles to emphasise:

• Always carry an EpiPen
• Always read food labels
• Ask questions about food preparation (be aware of the risk of cross-contamination)
• No label/no eat
• No EpiPen/no eat
• Tell friends about a serious food allergy
• Tell friends if feeling unwell, especially after eating.

I also support the International Alliance 2005 FAAA Initiatives, which include a LABELLING GOAL, which is as follows:

Ingredient labels will provide a reliable and consistent source of information for individuals who have food allergies.

Objectives:

• Major allergens clearly declared on the ingredient label with no exemptions.
• Simple language terms used on ingredient labels.
• Limit the number of precautionary statements and define them in clear terms.
• Encourage the development of criteria for the use of precautionary allergen statements to minimize their use, ensure that they won't be used in place of good manufacturing practices, and that they always appear immediately following, or adjacent to, the ingredient declaration.
• Improve communication between industry and the allergic community regarding product alerts.

We have come a long way and the listing of the EpiPen by the Minister for Health and Ageing Tony Abbott was a significant boost to those dealing with anaphylaxis threats on a daily basis.

There is more to do and I hope this excellent work and these processes in train have their desired and deserved outcomes, namely

• a safer environment
• greater understanding
• and supporting Allergic friends everywhere!

Let me leave you - more importantly those not here in the room with us tonight - with some important food allergy facts, courtesy of the Australasian Society of Clinical Immunology and Allergy:

• Currently, there is no cure for food allergy. Avoidance of the food is the only way to prevent a reaction.
• Food allergy is the leading cause of (severe reactions) anaphylaxis outside the hospital setting.
• It is estimated that up to 400,000 (2%) Australians, including 1 in 20 children suffer from food allergies and some of them will experience a life threatening (anaphylactic) reaction.
• A food allergic reaction can quickly become life-threatening.
• Adrenaline is the first line treatment for severe allergic reactions and can be administered via an auto-injector, called the EpiPen .

Information for schools and parents is available from Anaphylaxis Australia, as well.

• Immediate hypersensitivity to certain foods, with the potential for anaphylaxis and death, affects about 6% of children and 2% of adults.
• Characterised by sudden allergic symptoms on ingestion and confirmed by positive skin and/or radioallergosorbent tests, inadvertent ingestion of a food allergen may require self-injection with adrenaline using an EpiPen (self-injectable adrenaline device) and/or medical resuscitation.
• Food allergy causes about 25% of anaphylactic deaths in the United Kingdom.
• There is also the distressing scenario of administering and/or witnessing emergency treatment that affects everyone, including parents, friends, carers and schools.
• Peanut allergy has increased alarmingly in prevalence around the world in the past 10-15 years. In a recent NSW and ACT survey, 6% of preschool aged children were reported to be allergic to one or more of the common food allergens, and 2% were reported as peanut allergic.
• Although most children grow out of allergies to egg, milk and other common food allergens by the time they get to high school, 4 out of 5 peanut allergic children will retain the allergy for life.
• Anaphylaxis is the most severe form of allergic reaction and can be life threatening.
• Although infrequent, children with a clinically documented allergy to food are at risk of developing anaphylaxis if they accidentally ingest the allergen.
• Most deaths from food anaphylaxis are due to peanut or other nuts. Teenagers and young adults are at greatest risk, especially if they have asthma.

And finally, following a recent well-publicised incident, Magistrate Jacqueline Milledge, Senior Deputy NSW Coroner, handed down the findings from the coronial inquest into the tragic death of Hamidur Rahman on a school trip.

In total, seventeen recommendations were made, directed to the Minister for Education and Training, the Minister for Community Services, the Minister for Health and the Attorney General.

These recommendations include:

• Undertaking of allergy and anaphylaxis awareness training by all staff in schools, pre-schools and childcare centres.
• Continuation and expansion of the current NSW program of Anaphylaxis Nurse Educators.
• Conducting an audit of all schools and childcare facilities to identify children who suffer from allergies, and establishing a central register of information accessible to all staff.
• Introduction of legislation covering schools and childcare centres to make the protection of children at risk of anaphylaxis mandatory.
• A public awareness campaign.
• An awareness campaign for all medical practitioners in both general and specialist fields.
• Establishment of a register of deaths from anaphylaxis.
• Like many things in life, it often takes a death before people take notice.
• I hope that we can all work together to promote awareness and understanding of food allergies so that good health and long life are the messages that get through to the community.

Sources:

www.allergyfacts.org.au; www.mja.com.au; www.allergy.org.au; Australasian Society of Clinical Immunology and Allergy (ASCIA); www.britishairways.co.uk